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Found 8 matches for TOAST
We lead multidisciplinary applied research and training to rethink the way health care is delivered in general practice and across the community.
Economic analysis of oral dexamethasone for symptom relief of sore throat: The UK TOAST study
© 2018 Article author(s). Objectives To undertake an economic analysis assessing the cost-effectiveness of a single dose of oral dexamethasone compared with placebo for the relief of sore throat. Design A UK-based, multicentre, two arm, individually randomised, double blind trial. Setting and population Adults (≥18 years) with acute sore throat and painful swallowing judged to be infective in origin, recruited and randomised in primary care. Intervention: A single dose of 10 mg oral dexamethasone compared with placebo given at primary care visit. Main outcome Incremental cost-effectiveness ratios (ICERs), cost per quality-adjusted symptom resolution using the EuroQol-five dimensions-five levels instrument, were estimated as part of a cost-utility analysis performed on an intention-to-treat cohort adopting a health payers perspective. Results Differences in health-related quality of life (HRQoL) over 7 days from baseline and at 24 hours in the dexamethasone compared with the placebo group (2.9% and 2.5% higher, respectively) were observed. After controlling for the baseline HRQoL imbalances, the economic impact of the intervention was not statistically significant: The quality-adjusted life year difference was-0.00005 (95% CI-0.0002 to 0.00011) equivalent to a loss in HRQoL of a half hour in the dexamethasone group. The average cost per patient associated in the dexamethasone and placebo groups in the basecase analysis was £73 and £69, respectively. In the basecase probabilistic analysis, the mean ICER was-£6440 (95% CI-£132 151 to £126 335) and the median ICER was-£304 (IQR-£5816 to £3877); suggesting considerable uncertainty. Conclusions and relevance The economic burden associated with sore throat is substantial and was estimated at £2.35 billion to the healthcare services payer based on reported resource use and 2015 UK unit costs. There is considerable uncertainty regarding the cost-effectiveness of a single dose of oral dexamethasone as a treatment strategy and therefore insufficient evidence to support its use in clinical practice.
Diagnostic accuracy of Fever-PAIN and Centor criteria for bacterial throat infection in adults with sore throat: a secondary analysis of a randomised controlled trial
Background: Sore throat is a common and self-limiting condition. There remains ambiguity in stratifying patients to immediate, delayed, or no antibiotic prescriptions. The National Institute for Health and Care Excellence (NICE) recommends two clinical prediction rules (CPRs), FeverPAIN and Centor, to guide decision making. Aim: To describe the diagnostic accuracy of CPRs in identifying streptococcal throat infections. Design & setting: Adults presenting to UK primary care with sore throat, who did not require immediate antibiotics. Method: As part of the Treatment Options without Antibiotics for Sore Throat (TOAST) trial, 565 participants, aged ≥18 years, were recruited on day of presentation to general practice. Physicians could opt to give delayed prescriptions. CPR scores were not part of the trial protocol but were calculated post hoc from baseline assessments. Diagnostic accuracy was calculated by comparing scores with throat swab cultures. Results: It was found that 81/502 (16.1%) patients had group A, C, or G streptococcus cultured on throat swab. Overall diagnostic accuracy of both CPRs was poor: area under receiver operating characteristics (ROC) curve 0.62 for Centor; and 0.59 for FeverPAIN. Post-test probability of a positive or negative test was 27.3% (95% confidence interval [CI] = 6.0% to 61.0%) and 84.1% (95% CI = 80.6% to 87.2%) for FeverPAIN ≥4; versus 25.7% (95% CI = 16.2% to 37.2%) and 85.5% (95% CI = 81.8% to 88.7%) for Centor ≥3. Higher CPR scores were associated with increased delayed antibiotic prescriptions (χ2 = 8.42, P = 0.004 for FeverPAIN ≥4; χ2 = 32.0, P<0.001 for Centor ≥3). Conclusion: In those who do not require immediate antibiotics in primary care, neither CPR provides a reliable way of diagnosing streptococcal throat infection. However, clinicians were more likely to give delayed prescriptions to those with higher scores
Associations between exhaust and non-exhaust particulate matter and stroke incidence by stroke subtype in South London
© 2016 Elsevier B.V. Background Airborne particulate matter (PM) consists of particles from diverse sources, including vehicle exhausts. Associations between short-term PM changes and stroke incidence have been shown. Cumulative exposures over several months, or years, are less well studied; few studies examined ischaemic subtypes or PM source. Aims This study combines a high resolution urban air quality model with a population-based stroke register to explore associations between long-term exposure to PM and stroke incidence. Method Data from the South London Stroke Register from 2005–2012 were included. Poisson regression explored association between stroke incidence and long-term (averaged across the study period) exposure to PM2.5(PM < 2.5 μm diameter) and PM10(PM < 10 μm), nitric oxide, nitrogen dioxide, nitrogen oxides and ozone, at the output area level (average population = 309). Estimates were standardised for age and sex and adjusted for socio-economic deprivation. Models were stratified for ischaemic and haemorrhagic strokes and further broken down by Oxford Community Stroke Project classification and Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification. Results 1800 strokes were recorded (incidence = 42.6/100,000 person-years). No associations were observed between PM and overall ischaemic or haemorrhagic incidence. For an interquartile range increase in PM2.5, there was a 23% increase in incidence (Incidence rate ratio = 1.23 (95%CI: 1.03–1.44)) of total anterior circulation infarcts (TACI) and 20% increase for PM2.5 from exhausts (1.20(1.01–1.41)). There were similar associations with PM10, overall (1.21(1.01–1.44)) and from exhausts (1.20(1.01–1.41)). TACI incidence was not associated with non-exhaust sources. There were no associations with other stroke subtypes or pollutants. Conclusion Outdoor air pollution, particularly that arising from vehicle exhausts, may increase risk of TACI but not other stroke subtypes.
Problems people with dementia have with kitchen tasks: The challenge for pervasive computing
Technologies from pervasive computing can be used to ameliorate the difficulties that people with dementia have with multi-step tasks. This paper is intended to inform the design of technologies that help people perform daily tasks, by prompting them when they have difficulties, thus fostering independence and quality of life. Six people with mild to moderate dementia were video recorded performing activities of their own choosing in the familiar context of their own kitchens. In total there were 22 video recordings. Activities included making a cup of tea or coffee, a bowl of soup, beans on toast, or coffee with toast. The video recordings were transcribed using an adapted version of the Action Coding System. Incidents, where prompting was judged to be needed were categorised using a data-driven analysis as problems in: Sequencing (intrusion, omission and repetition), Finding things (locating and identifying), Operation of appliances, and Incoherence (toying and inactivity). Detailed examples of each type of incident, and the contexts in which it occurred, are provided as a resource for the design of pervasive computing solutions. What needs to be detected and what form prompts might take is specified for each category. © 2010 Elsevier B.V. All rights reserved.